§ 2.47 p.m.
BARONESS BROOKE OF YSTRADFELLTE rose to call attention to the Report of the Committee on Local Authority and Allied Personal Social Services [Cmnd. 3703]; and to move for Papers. The noble Baroness said: My Lords, I am submitting that a day of Parliamentary time should be devoted to the work of the Committee which was set up three years ago
to review the organisation and responsibilities of the local authority personal social services in England and Wales, and to consider what changes are desirable to secure an effective family service.
§ Their Report was published last summer and everyone concerned is warm in praise of the thoroughness and energy reflected in it. Within two and a half years they produced a wonderfully comprehensive document, with no packing to 1169 fill it out. It is full of rich meat. The Committee deserve thanks for all their work, and we have an opportunity to-day of thanking personally one of the members, the noble Baroness, Lady Serota. Knowing her capacity for work, I am sure she must have made her full contribution, until she had to resign because of being appointed to her present position in the Government. We are also indebted to Lady James of Rusholme, another member of the Committee, whose husband we look forward to hearing later in the day.
§ A great deal has already been written and spoken about the Report, both in the Press and at conferences specially convened to discuss it. I know this to my cost, for I have tried to read it all, as well as to study the Report itself. But so far there has been hardly any reference to it in Parliament. It was mentioned in the debate on the Address in another place, but at no great length; and up to now the Government have remained stubbornly mute. I would call it a black and white report. There is no compromising grey or off-white about it. Under its immensely vital and experienced chairman, the Committee worked intensively on the multiplicity of problems that faced them, made up their minds, decided what they wanted and then formulated more than 200 specific recommendations.
§ We often talk about broken homes and the break-up of families. The matter which the Committee had to grapple with was that the various social services which try to help the family are broken up, too. For instance, there is the children's service, dating back to the 1948 Children Act, to help children deprived of a normal home life. There are the personal social services provided by the health departments of local authorities, such as district nurses, health visitors and home helps. There are the welfare services provided by the welfare departments not only for old people but also for the blind, the physically handicapped and the homeless. Then, linked with the schools are the education welfare services, including the school health service, the child guidance clinics and so on. In addition to all this, there is a welfare side to the work of the housing departments which is brought constantly into contact with the needs of the family, as I have every reason to know, having 1170 once been chairman of a London borough's housing committee.
§ I have a great deal of sympathy for the idea which underlies the Seebohm recommendations: that the family is one, and ought to be thought of as one in helping its needs, and that there is something wrong in this present fragmentation of the services which are trying to do that. What the Seebohm Committee want is one family service geared to meeting as many as possible of the needs of the family. These needs may be different, but they all spring from one background—the background of that family and its home. To take the simplest example that occurs to me, if a child is persistently playing truant from school, no officer of a local authority may be able to get at the root cause of the truancy unless he or she can find out a great deal about life in that home from all angles.
§ The new provision in Section 1 of the Children and Young Persons Act 1963 helped, but it was still a matter of coordinating the different local authority services, whereas what the Seebohm Committee want is that these different services shall be amalgamated into one. They want this for the sake of every household: not only the families with children, but the childless couples, and individuals, often old people living on their own. As the family or household is one, so they maintain that the social services designed to meet its needs should be one. They would merge a variety of services into one department which they call the social services department of the local authority.
§ I think there is compelling force in the decision of the Committee to recommend that this new, unified family social service should be the responsibility of the local authorities. They are much nearer to the family needs and requirements than some remote area-based board selected and directed from Whitehall could possibly be. We want personal decisions and actions taken by committee members and officers and field workers who live on the spot, or near enough to it to be in touch. We want to avoid long-range examination of impersonal paper problems, and instead to have human contacts which will convey the human's needs.
§ A strong local team of social service workers with adequate resources in training, buildings and finance is a Ix sic requirement for the set-up of this new 1171 department, together with the friendliest co-operation and support of all the voluntary services already in the field who have done so much pioneer work in the past, and without whom a community service in its fullest sense could not exist.
§ It may well be argued that these family services are already satisfactorily administered by the local authorities, who provide the welfare department, the children's department, the domiciliary care of the elderly, the sick, the maternity cases and so on. There are housing managers and rent collectors; health visitors and district nurses; domiciliary midwives and education welfare officers. But they all spring from different sources, and are answerable to different committees and different chief officers. Some division of loyalties is inevitable, and in spite of the excellent work that has been undertaken by many of the enlightened local authorities in providing as good services as can be available under the present arrangements, and in spite of the successful collaboration that has been effected between some of the local authority health departments and other branches of the National Health Service, there remain deficiences and anomalies.
§ Some of the deficiencies seem to stem from lack of imagination. Furthermore, far too little is known by most of the public as to what is available. What sometimes happens is that some of the services are hidden away in forbidding-looking buildings where is would almost seem it was not intended that they should be easily discovered. Sometimes they are dispersed in distant corners of the local authority area, with scant instructions as to how to get from one to another. Publicity and directions are needed, attractively presented, readily available and comprehensible to all. An end should be made to the exhausting trek from one office to another which the present fragmented services too often entails. Mothers with small children should not have to trail around from office to office to find the right services that they need.
§ Take an extreme example, of a not very bright mother with a mentally subnormal child who has to be with her all the time, another child at a primary school who has to be taken and fetched, and a baby needing diphtheria or polio 1172 immunisation at the child welfare clinic, as well as an elderly, blind, sick father, who is also living with her, requiring the help of the district nurse and the chiropody service, and the whole household is calling out for the services of a home help. There is no telephone in the house, and several different welfare departments need to be notified. How does she cope? The answer is that often she does not; she gives up. In Seebohm's Utopia, we are led to believe that one social welfare worker member of an area team might be the answer. If that is really so, it would open up a wonderful new era for harassed persons hopelessly overburdened with such home problems. This is an imaginary family, but real ones like it in lesser or even greater straits are to be found all over the country. They are the Pilgrim Mothers of to-day.
§ It is often only when a practical and thoughtful member of the public happens to come on the receiving end of welfare services that an intelligent appraisal of existing conditions gets made from the recipient's point of view; and even that, by itself, is not enough. The appraisal having been made, steps should then be taken with real intelligence and drive to make representations to the appropriate authority as to what further could be done towards more humanising of the arrangements.
§ At present, the waiting lists for residential care of the mentally ill and subnormal, the handicapped and the old, are lamentably long in many parts of the country. Often there are shortcomings in the meals-on-wheels service—and this is not a criticism of those who supply as good a service as they can; it is just an example of the present situation. After all, not many of us would like to approach the week-end with little hope of a hot meal of any sort throughout Saturday and Sunday. But there are rarely meals-on-wheels on those days for those dependent on the service. There is nothing like a sufficient number of home helps available. It is easy to imagine the consternation of some elderly person living alone, dependent on the regular visits of a home help, suddenly to have her taken away because some other person is judged as being in even greater need of her help.
§ While on the subject of home helps, why cannot we have many more male 1173 home helps? There is scope for men, as well as for women, in this field. I remember so well the opposition that was aroused when I wanted to introduce male district nurses. But those of us who were convinced that there was a place for them plodded on, and to-day there are 600 of them in the domiciliary field. Last November, the Queen Mother presented the first long-service badge, representing twenty-one years' work, to a male Queen's Nurse.
§ I hope everyone will agree it is right that, if we are to have a family social service of this sort, it should be the responsibility of the local authorities. How they can best tackle it is a big question for discussion. It needs examination of the present organisation of each local authority department responsible for these personal social services. After serving as a member of a local authority for eighteen years, I believe that it would be better to allow for a fair amount of flexibility in local administration, rather than to impose detailed control or mandatory committees upon it.
§ It is reassuring that the Seebohm Committee have such confidence in the value of local democracy. But is it consistent to accept the principle and, at the same time, to seek to impose upon its democratic framework a mandatory committee insisted upon from Westminster? If the main recommendation is accepted, the local authorities should be left to work out and carry out the administrative work appropriate to the setting up of the new department. I believe that the local authorities will rise to the challenge and voluntarily set about the necessary new organisation. I know that there is concern in some quarters that before and since the publication of the Report some local authorities have been taking piecemeal action by reorganising their social services in ways which are thought to be contrary to the Seebohm Committee's proposal. I expect the Government are aware of this concern too. From now on, I hope there will be no further reorganisation except such as will fit in with the Seebohm scheme.
§ In Scotland legislation on the Kilbrandon Report has been passed and the new service there is coming into being. The noble Baroness, Lady Elliot of Harwood, is involved in the setting up of 1174 the new service there. She is a devoted and experienced exponent of the best for social welfare. I believe she is hoping to give us the conclusions from her own experience later in this debate, and this will be of great value.
§ But to return to our own Seebohm Report, the first chief officer responsible for the suggested new social welfare department must be of comparable calibre to the other chief officers already in the field—in finance, housing, the medical officer of health, the chief engineer, and so on. Some doubt has been expressed as to whether sufficient men and women up to the job will be forthcoming, but I am not pessimistic about this. To me, the one thing that must he avoided at all costs is the unsuitable appointment of an existing local government officer simply because lie may be in danger of becoming redundant if he is not given the new post. This has been known to happen in the past, with disastrous results locally. Much better to retire such a person with proper compensation than imperil the future of the new department.
§ One of the most dramatic changes Seebohm envisages with the setting up of its new social services department is the break-up of the unity of the existing public health and welfare services in such areas as mental health and the care of old people, where co-ordination is of the greatest importance and it is difficult to draw lines of demarcation between health and social interests. I will not enlarge on this point, for I know that the noble Lord, Lord Amulree, is going to discuss it from his very considerable exprience and knowledge.
§ The Committee's recommendations would inevitably reduce the powers and the status of the health department and take away from the medical officers of health a sphere of work in which many have developed a great interest and in which some first-class work has been done. By proposing the new social service department, and by making it separate from the health field, one would think that the Committee were creating a fresh need for new co-ordination and co-operation. I must confess that the rather cavalier way in which the health department, its chief officer and its work are referred to in the Report seems to 1175 me ill-calculated to create a climate of medical opinion in which co-operation is likely, at least at the start, to be wholehearted. I hope I am wrong.
§ The success of the new departments will stem at the outset from the personality and experience and administrative skill of the chief officer. I am strongly opposed to chief officers being appointed by Ministers. If there must be ministerial supervision, I would far rather see something comparable to the practice already in being for chief constables, where the police authority submit a short list of names to the Home Secretary, who may approve it in toto or may delete the name of someone not considered adequate, or may add one or two names to it, and then returns it to the police authority to make their final choice.
§ This brings me on to the question of training for this new department. At present there are three main training bodies, three national councils for training in social work, all responsible to Ministers: the Central Training Council in Child Care, the Council for Training in Social Work and the Advisory Council for Probation and After-Care. One is bound to ask whether this is educationally right and whether it is likely to make the best use of scarce resources. Each Council is fishing for students in the same pool and each needs its own separate teaching staff. Each is promoting separate courses, sometimes in the same building. The case for unified planning of social work training seems overwhelming, and that is something that can be started upon straight away. It is a Government responsibility, and it is in their hands to start unification without delay.
§ I am not clear whether the Committee thought out the question whether a wider training in the whole social welfare field could be achieved without lengthening the period now required for the present separate and more limited training courses. Can more breadth be obtained within the same time without loss of standards? The recommendation to provide more courses for married women would have been warmly welcomed by me if it were not for the sorry development that is poisoning the process of bringing married women back into teaching. That idea, having received Govern- 1176 ment acclaim, and thousands of married women having made the considerable effort to return on a part-time basis, they are now among the first victims of the Government's policy of squeezing educational expenditure, for local education authorities are sacking or not replacing their part-time teachers as a means of keeping their expenditure within the Government's limits. Once bitten, twice shy!Middle-aged married women may be wary of being caught again.
§ Whether unified social service departments can justify themselves will depend almost entirely upon the quality of the initial staff. At first, unevenness in the amount of training and experience will be inevitable. But, given inspiration and the right leadership from the top, it should not be impossible to get the right contribution from every member of the staff, whether he or she is one of the professionally trained people taken over from the separate departments, or the old-time social worker without academic training but with much experience, or the new type of social worker emerging from the new type of training. I am sure that great wisdom will be needed to get the team to work together—wisdom and patience and faith. But I have no doubt it can be done.
§ Training leads me on to the necessity for a satisfactory career structure to encourage the right type of recruits into training in the first place. The main resource of the personal social service in going about its work is not plant but manpower; and the Seebohm Committee believe that a unified department will have the advantage of attracting sufficient numbers of recruits by providing a better career structure, because it is going to be a much larger, more interesting and worthwhile service. I am sure the career structure is as important in social work as it is in the teaching profession.
§ My Lords, a keynote of the Report is urgency in implementation. Personally I have every sympathy with the Committee's enthusiasm, but I am not sure that on the long view this immediate haste is wise. It might prove to be a case of "More haste, less speed". We have had the Minister of Health's Green Paper reviewing the National Health Service; we have had the Seebohm Committee's Report. We are awaiting the 1177 Report of the Royal Commission on Local Government in England and Wales. There are Seebohm recommendations that do not need to wait for legislation and can be put into force straight away, such as the use of greater imagination in the presentation of the available services, the unification of training, further consideration of the future of the psychiatric services and further study of the implications of the Report as they affect the Probation and After-Care service. These should be in train already. I think we are justified in looking to the Government for a broad statement of their policy towards the main recommendations of the Report. It is essential that the Government should now be guiding the local authorities as to whether the Seebohm structure is to be the plan for the future.
§ As soon as the Report of the Maud Commission is available for study the Government should come out, as quickly as possible, with their combined plan for the future organisation of local government and of the National Health Service and of the personal social services, drawing on the tremendous amount of work and research that has been undertaken by the members of all three bodies. I am sorry to have to say it, but at the moment there is an atmosphere of uncertainty, productive of despondency and shrinking morale in all these three fields of work. Until a clear picture of the future emerges—and here lies the overwhelming need for speedy decisions —this sad state of affairs will continue. "On! Maud, on!", should be Seebohm's battle cry. In the meanwhile, let the imaginative brains in local government and among the voluntary organisations and in Mr. Crossman's new Department examine constructively all that is practicable in the Report, so that, their homework done, they will be ready to get on at the first possible moment after the Maud Report has been presented and digested.
§ My Lords, I am no professional social worker. I am not a medical officer of health—I am more like the not very bright housewife, to whom I have referred. It is inevitable that I have only been able to skim over the surface of this long and closely packed Report. Noble Lords of much greater experience and knowledge than mine are intending 1178 to speak to-day, who will make good the gaps in my sketchy introduction. There is no Party political issue, so far as I am aware. The welfare of every family in the community merits universal care and consideration. Whether we are dealing with social casualties or normal, healthy individuals, I see the community itself as a family where the strong should support the weak and where the weak should be encouraged to help themselves.
§ Seebohm has woken us up. It has opened many eyes and alerted many ears and has made people think. It is up to us to continue where the Report leaves off and to examine how far and how fast and by what practical action we can travel forward to the goals which it has set before us. My Lords, I beg to move for Papers.
§ 3.14 p.m.
§ LORD AMULREE
My Lords, we are grateful to the noble Baroness for giving us such a good and comprehensive review of this rather complicated Seebohm Report. I do not intend to follow her along those lines, but I want to pick out one or two points from the Report on which I hope the Government will be able to give me some reply.
In the first place, I wish to say that I join in the general welcome given to the Report by the noble Baroness. It is one of a series of Reports dealing with local authority services which have been coming out at quite long intervals. There was the Jameson Report or Health Visitors, in 1956; the Younghusband Report on Social Workers, in 1959, and now this present Report. I believe one can complain at the piecemeal way in which the services have been tackled over quite a long period of time, and I am afraid that the criticism I have made about the piecemeal nature of the Reports must also apply to the Report of the Seebohm Committee, because there are two most important types of social worker not included in the terms of reference of the Committee. The Committee cannot be blamed for that; indeed, they referred to it themselves. I refer to the medical social workers and the psychiatric social workers who are employed by the National Health Service and not by the local authority. If one is dealing with children or with old people it is very difficult indeed to draw a dividing line between the work of the 1179 National Health Service and the work of the local authority.
I should like to say a few words about the medical social workers, because they are the people with whom I have had particular dealings over a long period in the past. I think one has to make up one's mind whether they are primarily social workers in the social service or medical auxiliaries. If the first alternative is taken and it is decided that they are primarily social workers with a medical interest and background, and must therefore work with the medical side, they will surely be out on a limb, as one might say, if the social service committees do not include them.
I should like to suggest to the Government that the medical social workers and the psychiatric social workers should be part of the social service department but that, instead of being given general training and general duties, they should be seconded to the medical departments and the psychiatric departments of the hospitals; and when I say that, I mean seconded for long periods of time; I do not mean that they should be changed every six months. In my view, that would overcome some of the difficulties connected with the National Health Service social workers at the present time, in the sense that they are not paid as much as the local authority social workers and it is therefore difficult to maintain recruitment.
Furthermore, the value of hospital work in the training of social workers, particularly the medical social workers, may follow from their attachment to the department. If they are to continue to be purely hospital-employed workers, working entirely in the National Health Service, I do not see how they can survive in a satisfactory way as a profession if they are to be cut off entirely from the main body of social work and workers. I know that an inquiry is being held in York at the present time, partly financed by the Ministry of Health, into the future role and function of the medical social worker, but I do not think it will be ready to report for quite a long time—I believe it will probably be several years—and I do not think we have that long time to spare before we can make up our minds what is going to become of them.
1180 Again, I believe there is a need for a link between the residential homes (I am referring, of course, to residential homes run by the local authority) and the hospitals. This is dealt with in paragraph 307 of the Report. The Committee expressed the hope that the medical staff, and particularly the geriatric services, should be called upon to assist in deciding which people should go into residential homes and which need a period of treatment in hospital to see whether they can be restored to a greater degree of health in that way. I very much hope that some arrangement will be made to achieve that objective. This is something which does go wrong at the present time. The other day I came across a patient who had been for four years in a small local authority home for confused people. Her condition was deteriorating and the local hosital consultant was called upon to examine her. It was found that she was suffering from a thyroid deficiency, which was probably the cause of her breakdown in the first place, but it had not been spotted. She was treated for this in hospital and she made a gradual recovery. That is the kind of danger one sees.
I know quite well that joint appointments are not popular. They are not popular with the authorities, and they are not really popular with the medical staff of hospitals, because they fear—and I think their fears are quite justified—that if they are going to be partly appointed by the local authority and partly appointed by the National Health Service a considerable amount of local pressure will be brought upon them to admit people out of their turn into residential homes or to hospitals. That is something at which I do not take particular offence or worry about: it seems to me a normal thing that one should try to get one's senile grandmother into a home as soon as possible. But it may lead to uncomfortable pressures. Supposing there is not some kind of medical vetting or examination of these people going into residential homes, we are going to be back to the old mixed workhouse of the Poor Law, and a great many people will be admitted because they are in trouble or infirm and no one knows what is wrong with them, and will be simply kept in bed till they die. That is the sort of thing we thought had gone in 1945, certainly in 1948 when the Health Service came in; 1181 but I rather fear that it may come back if some provision is not made for such people.
I think there is a great deal to be said for the linking, of the social service department with the housing department. I read the other day in a long report by the Government Social Survey that about 20 per cent. of people admitted into Part III accommodation under the local authority could really be in sheltered housing. Therefore, I wonder whether it would not be possible for the social service department to take on the sheltered housing and not leave it with the housing committee.
One must not hope for too much or for things to come along too quickly. The Committee seemed to me to be rather optimistic about the amount of money that would be poured into their coffers, and that sort of thing. But I think quite a lot of good work will be done. The fact that the home-help service is to be transferred from the health department to the social service department does not mean that there will be many more people available to be home-helps. I would support what the noble Baroness said about getting male home-helps, because we served together on the Council of the Queen's Institute and I know what a great success the male nurse has been on the district nursing side. I do think that is a reasonable thing to do.
I do not object to this committee or department being a statutory one. There are quite a number of other statutory committees in local authorities. County councils have about 10, I think; and there are quite a number of statutory officers. There are the clerk and the treasurer, the surveyor and the medical officer of health; and in the county borough and urban district councils there is the chief health inspector. So I think it is quite a reasonable thing that the committee should be a mandatory one, or a statutory one. What I would suggest is that some kind of inspectorate might be set up by the Ministry. I do not mean a nasty inspectorate, going snooping around looking for trouble, but something like the inspectorate under the Ministry of Education. The H.M.I.s are first-class people, who do excellent work and give advice and encouragement. In the same way there was an inspectorate service under the old Poor Law which did not go looking for trouble but was encouraging and helpful.
1182 I am pleased that the children's department is going to be included in the social service department. When I looked up the debate on the Second Reading in your Lordships' House of the 1948 Bill I was pleased to find that I had expressed a certain amount of disquiet that the deprived children were going to be put in a separate department run by a separate Government Department. I am glad to see that they are now coming under the same local authority department, and I hope that the probation service will come in in due course. But I think there is need for the Government, to-day if they can, to say what their intentions are. It may be that we shall have to wait for the implementation of that until the Report of the Maud Commission comes out, but certainly at the present time there is a good deal of discomfort among the staffs of the social service departments and there is difficulty in getting recruitment for them. One has seen in the papers and heard elsewhere that certain local authorities are taking their own steps to forestall the Seebohm recommendations, and that is going to cause some confusion in the future if ii has to be undone again.
My Lords, I want to say this, in conclusion. I am not quite sure what is going to become of the medical officers of health. They have had a long and distinguished service. I quite see that much of the work they do will be absorbed into the work of the new social service committee. The Report talks about a community physician. I do not know what that means and I doubt whether people outside the Seebohm Committee know what it really means —indeed, I sometimes wonder if the Committee themselves knew what it meant. I want to end on a rather sad note, having touched on the medical officer of health. It does look as if the status and responsibility of the doctor, of the medical profession, in the social service work is going to be reduced, and I would ask whether that will be in the best interests of the patient; and I refer particularly to the young patient and to the old.
§ 3.28 p.m.
§ THE MINISTER OF STATE, HOME OFFICE (LORD STONHAM)
My Lords, I am sure that we are all greatly indebted to the noble Baroness, Lady Brooke of Ystradfellte, for creating this 1183 opportunity to debate the Seebohm Report. We are also grateful to her for her speech, which was a survey which I found by no means sketchy but indeed a very comprehensive one compressed into 25 minutes. I would also thank the noble Baroness for the manner in which she set out the problems and even for her highly critical and even caustic comments, not all of which I agreed with. I will not at this stage enter into detailed arguments about the case put forward by the noble Lord, Lord Amulree, except to say that it would be unthinkable that in the social services the medical services should not continue to play a full part. Exactly how that part would be labelled would no doubt depend on circumstances in different places.
Seebohm is already recognised as constituting a major contribution to our thinking on the lines of advance in the social services for decades ahead. It is a monumental Report, and I should like to add my tribute to that paid by the noble Baroness, Lady Brooke, to the Chairman and members of the Committee, including my noble friend Lady Serota, for the breadth of view and care which they brought to their comprehensive study of the personal social services and the sheer hard work which in two and a half years produced this closely reasoned Report of more than 700 paragraphs and upwards of 200 recommendations.
Your Lordships will recall that the Committee were charged with the task of reviewing:the organisation and responsibilities of local authority personal social services in England and Wales, and to consider what changes are desirable to secure an effective family service".The idea of a family service has naturally developed in the context of the care of children. I believe there is general agreement that the organisation of the children's service set up by the Children Act of 1948 has succeeded in ensuring that children in the care of the local authority are well provided for. Our present problem is to find the best organisation for ensuring that children living with their own families are well cared for, and unquestionably this involves promoting the welfare of the family as a whole. Precisely the same point has emerged in consideration of the care of 1184 the elderly and of the handicapped: family support has been increasingly seen to be the key to their life at home and thus statutory and voluntary support for the family is no less important than support for the individual.
From 1948 onwards Government Departments have given guidance, severally and jointly, to local authorities about coordination of services for children. In 1960 the Ingleby Report on Children and Young Persons led to the further powers conferred by the Act of 1963 to cover advice, guidance and assistance to forestall or repair family breakdown. Ingleby commended further study of the idea of reorganising local services to provide a family service, and this idea gained further support in the Labour Party's study report for which my noble friend Lord Longford, was largely responsible. The next step was the Government's decision announced in the summer of 1965 in the White Paper, The Child, the Family and the Young Offender, to appoint an independent committee to consider the organisation of the local authority personal social services, and the Seebohm Committee was established at the end of the same year.
This was the immediate point of origin of the Report we are considering, but it is right for me to acknowledge that there had been a growing conviction among many of those concerned with a wide range of personal social services that a fresh and comprehensive examination of these services was urgently required. Since 1948 the services had expanded greatly in terms of staff and work done, and their structures and methods of work had been modified under the influence of changing needs and changing concepts of how these needs should be met. Moreover, important powers and duties had been conferred on local authorities by the Mental Health Act 1959, by the Children and Young Persons Act 1963, and, since the appointment of the Seebohm Committee, by the Health Services and Public Health Act 1968 which, when implemented, will, among other things, enable local authorities to provide or promote any welfare service for the elderly which is not already within the competence of some other statutory body. Furthermore, during the present Session the Government propose to enlarge the functions of children's departments by the Children and 1185 Young Persons Bill, which would give effect to the proposals in the Home Office White Paper, Children in Trouble. In addition, over the years different parts of the personal social services have come under examination. I am thinking particularly of the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, the Younghusband Working Party on Social Workers in the Local Authority Health and Welfare Service, the Ingleby Committee and, of course, the notable series of reports from the Central Advisory Council for Education. Again since the appointment of the Seebohm Committee there have been Reports from the Williams Committee appointed by the National Council of Social Service on the provision of staff for residential homes and from the Summerfield Working Party on educational psychologists. None of these Committees, however, was permitted by its terms of reference to examine the organisation of the local authority personal social services as a whole, although most of them emphasised the need to improve coordination between the various services.
I thought it right to sketch in this background just to emphasise the amount of work and degree of thought which has already been expended on these matters and the wealth of experience which already exists to help us in weighing the Seebohm recommendations and considering how best we should now proceed. The noble Baroness gave what I thought was excellent advice when she said that she was doubtful that immediate haste is wise, and then almost immediately afterwards she urged the Government to make a broad statement of their attitude to the Report. I do not know how desirable this is, because she said, "On, Maud, on!", not "Come into the garden, Maud." At least we have to wait for Maud and a lot of other things, before we can be so definite, particularly as in the two speeches we have heard already we realise the wide variety of opinion, and indeed well-informed opinion, there is on these matters.
Central to the Seebohm recommendations, and much of the thought which has preceded them, was the question of the organisational structure of the personal social services, and I will return to this later because it is here that the critical decisions for the Government will 1186 lie. But we should not forget that these are questions of means to the end of better care for all the socially deprived and that, within the context of their structural recommendations, the bulk of the Seebohm conclusions are concerned with ways in which the services for people in need—for children, the elderly aid the physicaly and mentally handicapped—may be improved.
The further development of these services must, to a great extent, depend on available resources—of skilled manpower as well as money, as the noble Lady said—but it should not be overlooked that, even with our present forms of organisation, steady progress, not ill-co-ordinated, has been achieved. Indeed, I think it will help us in the forthcoming discussion if your Lordships take cognisance of and acknowledge some of the achievements in the field of social welfare in the four years since this Government took office, achievements in which, considering the constant financial difficulties, the Government and the country have the right to take pride.
One of the first services to consider is housing. The Seebohm Report states categorically that the Committee do not consider that an effective family service can be created by changes confined to the personal social services alone. They recognise that one of the basic requirements for that family service is better housing. In the public sector, the number of new dwellings completed in England and Wales rose from 102,400 in 1963 to over 158,000 in 1968—that is over 50 per cent. more in four years—and the total number completed, including both public and private sectors, rose from over 270,000 to more than 371,000. If we look at the total number of unfit houses in clearance areas demolished or closed, there is an increase of 25 per cent. in the same period. Later this Session your Lordships will be turning your attention to a major Bill which the Government propose to introduce to implement the proposals in the White Paper, Old Houses into New Homes, in which my noble friend Lord Kennet played such an important part, and which will seek to raise the upper limits for housing improvement grants, widen their scope and make them more flexible, and introduce a new grant for environmental improvement.
1187 Another basic requirement for an effective family service which Seebohm mentions is adequate social security benefits. Here again there has been substantial progress in the four years. The basic rates of unemployment, sickness and retirement benefits have been raised twice, in January, 1965, and October, 1967, to new record level in terms of purchasing power. War pensions, industrial injury benefits, widows, maternity, death grant and other benefits have also been increased.
The Government proposals for a new National Superannuation and Social Insurance Scheme were published yesterday. It is the most fundamental change in social security since Beveridge. Short-term sickness and unemployment benefits have been related to earnings since 1966. It is now proposed to extend the principle to retirement pensions and at the same time provide an adequate level of benefit for all. Furthermore, for the first time ever it is proposed that a guarantee should be given of a regular review of benefit rates to ensure that the real value of pensions is not eroded by inflation.
The Report's third basic requirement for an effective family service is good health services. Again, very encouraging progress has been made.
I would also invite your Lordships' attention to a quite different field—the increased provision of services for elderly people of 65 and over. Once more there are advances to record. The number of elderly people for whom local authorities were providing residential accommodation, either direct or in homes run by voluntary organisations, went up over the last four years from 82,809 to 95,433, and the number of homes for the elderly provided by local authorities rose from 1,552 to 2,050—another quite substantial advance. The number of elderly people receiving home help, a subject mentioned by the noble Baroness, increased from 266,000 to 338,000—an increase of 27 per cent. There were increases, too, in the numbers of elderly people receiving home nursing care and visits from health visitors, and 25 per cent. of local authority housing programmes now consist of small units suitable for elderly people.
A word, now, about services for the mentally disordered and physically handicapped, which the noble Baroness also 1188 mentioned. Regrettably, some of these are relatively late developers among the social services, and in the past they have lacked the help of trained professional staff. The Council for Training in Social Work has done and is doing much to make this good. Substantial numbers of certificated social workers have already been trained and 600 finished their training last year. We look for further growth as economic circumstances permit. The Council is also turning its attention to the training of staff of residential homes, and hopes to promote three or four courses for the staff of homes for the elderly and mentally handicapped this year. The number of local authority child care officers has also increased remarkably, from 1,773 in 1964 to 3,036 on March 31, 1968. The output of training courses in England and Wales for these officers has increased from 166 in 1964 to 400 in 1968.
My Lords, I think you must agree that these examples prove beyond question that we have made substantially increased provision for the care and well-being of those in need, although in the same sentence I acknowledge that provision is still not nearly enough. The Government are not in any way complacent about what has been achieved. We know only too well how much still remains to be done. Nevertheless, there is solid progress being made, and it would be churlish not to acknowledge it. The process continues because, as my noble friend Lady Serota said last week on the Second Reading of the Local Government Grants (Social Need) Bill, the Government are now actively considering community development projects to tackle by new methods poverty and deprivation in selected areas.
This kind of project which the Home Office is pioneering marks a new departure in the development of the social services in this country. I am not quite sure whether I heard the noble Lord, Lord Amulree, aright, but I can assure him that so far as central control of the children's social services is concerned the Home Office is continuing. In the first place, this new project would take a number of assumptions, or hypotheses, about the nature of poverty and deprivation and build on them a strategy for finding the best ways of tackling these problems. For instance, its approach will reflect the view that families suffering from 1189 chronic poverty or dependence on the social services are, for the most part, not found here and there, dotted about in prosperous and self-sufficient areas: they tend to be found together, in fairly large concentrations, in areas which are physically decaying and perhaps suffering industrial decline and other troubles.
Second, it seems perfectly clear that "more of the same", in the sense of additional help of a traditional kind, provided through the existing structure of the social services, will not be effective in bringing about a lasting improvement in the life of these families, useful as it may be as a temporary support. Third, is the very important belief that there are resources of self-help in the community which, if ways could be found of mobilising them, could be of enormous value in supplementing—perhaps even replacing, in some instances—the help provided by the professional: and therefore what is needed is to experiment with ways of generating more mutual help and more voluntary activities which will, we hope, take some of the load off the shoulders of the professionals.
Again, this project will be concerned to find ways of helping those in need express their needs to the relevant services, and to influence the services to be more responsive, more sensitive to the feelings, as well as the needs, of the client. This reflects the belief that there are, even now, many whose needs are not perceived by the social services, because they do not know how to communicate them or whom to communicate them to. I think the noble Lady described people like that as the "Pilgrim Mothers" of to-day. Finally, we are acting on the belief that we do not yet know the answers; we have to experiment, to be prepared to look at quite new, unconventional approaches to the problems of poor people in poor neighbourhoods and ways of helping them to stand on their own feet.
What the Government have in mind, then, will be a co-ordinated experiment in a number of areas which appear to contain large numbers of people suffering from poverty and deprivation, aimed at finding out how to make the social services more effective in supporting them both by better co-ordination between services and by making the services more accessible and comprehensible in their 1190 dealings with those in need. I should remind your Lordships that I am speaking within the limits of the Bill which I mentioned, but would emphasise the breadth of this approach. We shall not only be concerned with those services reviewed in the Seebohm Report. The scope will be considerably wider. It will bring in all the statutory services, whether central or local; and any voluntary organisation which can contribute to the aims of the experiment and offer resources of its own, whether people, money or buildings, to back up the local programme of action, will be welcome to take part. We hope to start soon and there will be a full Government statement whey negotiations with the local authorities have made further progress.
The Government act in constant awareness of the fact that the social services we are discussing must be looked at simply as the moat highly organised expression of the concern of the community at large for its least fortunate members. Outside the organised services there is, as all of us know, a great wealth of personal service rendered without any thought of its being labelled in any way as social work, or indeed labelled or recorded at all. The housewife who keeps a close eye on her elderly relative, the neighbour who comes round to help at a movment of family crisis, are all making their contribution in this field, and so, of course in a very special way are those great voluntary bodies who canalise and direct the efforts of so many volunteers and those out of whose efforts the welfare services have almost literally grown. For my part, I am sure that there will always he a place for voluntary service in a fruitful partnership with the statutory services. It is the experience of most of us that because society is constantly raising its standards, the more we do by statutory provision the greater the field for voluntary participation. Indeed, as the noble Baroness, Lady Brooke, said, without the volunteers a real community service can scarcely exist.
But, as I have said, the Seebohm Committee's central recommendations relate to the future structure of the local authority personal social services and in particular to the creation of a new local authority social service department spanning the present services provided by the children's departments and by the welfare services under the National 1191 Assistance Act 1948, and including also certain social work services now provided by health and education departments and in some cases by housing departments. This is a matter upon which some division of opinion has already made itself felt in public comment, and indeed in this Chamber, notably as regards the division between health and welfare, and it is upon this question of organisation that the Government have been particularly anxious to obtain the comments of interested bodies.
More than fifty organisations, covering local authority professional and voluntary opinion, were specifically asked to comment by the Departments concerned, and a more general invitation was issued in the Press. Comments, or et least preliminary views, have now been received from well over seventy bodies. These are now being studied and it would be premature for me to forecast what conclusions may emerge from this consideration. It will be a colossal task to digest and correlate all the reports which have been received, and the very important report which still has to be received, and the opinions expressed upon them by so many bodies, and indeed the opinions which will be expressed in to-day's debate, following as it does hard on the heels of the Report.
Comment has been sought and received both from professional bodies who are properly concerned in their several ways with the reaction of the Seebohm recommendations upon professional needs as they see them, and also from the local authority associations who have a particular interest in the administrative aspects. Much of this comment was conscious that the Seebohm Report, in the field which it covers, is but one element in the major process of restructuring which lies ahead of us. Seebohm does not and cannot stand alone. It has to be considered in the context of the reorganisation of the Health Service, on which my right honourable friend the Secretary of State for Social Services is now considering the comments received on the entirely tentative proposals advanced in the Green Paper. One must have regard to the proposals regarding the size and function of local authorities which we are eagerly await- 1192 ing from the Royal Commission on Local Government in England, whose work is now drawing to a close. Also relevant and already issued and under study, is the Report on the Management of Local Government, from which the Seebohm recommendations differ in a material respect. It is no accident that all these Reports should be coming before us at about the same time: all affect the same large question of the future organisation of the administration of the social services; and your Lordships will, I believe, agree that it must be wise to weigh all these topics together before seeking finally to conclude upon any one of them.
I realise that, as the noble Baroness said, they have ordered these things somewhat differently in Scotland where, following the Kilbrandon Report of 1964 and the October. 1966, White Paper on Social Work and the Community, and the resulting Social Work (Scotland) Act 1968, preparations are being made to bring into being local authority social work departments with comprehensive powers covering the whole field of child care, welfare, social support of the sick, supervision of offenders and after-care of prisoners, and with a duty to promote social welfare and to give advice and help to people who need it. But it does not follow that the organisation of these services need necessarily be identical throughout Great Britain, and when the Scottish White Paper was published the Government made it clear to the local authority associations that these proposals had regard to the particular circumstances of Scotland and that they were not to be taken as creating any presumption that the form of organisation of the local authority personal social services there presented would be applicable to England and Wales.
This process of consideration is bound to take some further time and I realise that this may be held, and probably will be held, to run counter to the Report's recommendation for swift action without waiting for the Report of the Royal Commission or of other inquiries. I particularly recognise the uncertainties to which the Report may give rise, and probably has given rise, in this interim period in the minds of many local authority staffs, the strains on morale which this may 1193 cause and the dangers, of which some signs are already apparent, that some local authorities will seek to reorganise their personal social services in a way different from that which Seebohm had in mind or that which may emerge from current discussion and consideration as the best solution of the problem. The Ministers concerned when answering questions in another place, have already urged upon local authorities the wisdom of not making changes in organisation which might pre-empt the Government's conclusions, and this has been drawn specifically to the attention of local authorities. This remains the Government's view. We do not think it right, on account of these anxieties, to try to take piecemeal decisions in this complex of problems without viewing and weighing up the other elements. After all, the pattern which we shall be moving to establish may well govern the personal social services for a period stretching into the next century. We must do all we can to get our decisions right. In doing so, we shall have in mind that we are serving not only administrative and professional efficiency but the happiness and well-being of millions of people who are among the most vulnerable in our society.